Book Reviews

Now that the Cold War is over, a critical question for historians is whether it had to last so long. Were there moments when things might have gone differently, when the leaders of the great powers might have broken the grip of suspicion and fear that for forty years made an armed camp of Europe, a ruin of large parts of the rest of the world, and nervous wrecks of billions of people who wondered when Armageddon would begin? Of the candidates for such an alternative history, the summer of 1955 has always been one of the most intriguing. The conclusion of the Austrian State Treaty in May 1955 made that country a potential model for a larger demilitarization of Europe. A summit conference in Geneva in July—the arst face-to-face meeting since 1945 of those responsible for the Cold War—raised hopes all around the world that the Cold War might end and a genuine peace ensue. Those hopes were dashed; and the authors and editors of this ane collection explain why. The editors, Gunter Bischof and Saki Dockrill, and the keynote speaker at the 1995 conference for which these papers were originally prepared, Ernest May, ably establish the background for the Geneva conference. Richard Immerman assesses American expectations in the leadup to the summit, especially the tension between the very reluctant John Foster Dulles and the mildly more forthcoming Dwight Eisenhower. (Dulles gets a second chapter all to himself, by Ronald Pruessen.) Vladislav Zubok shows the new Soviet leadership striving to break with the Stalinist past but failing to escape the shadow of Joseph the Terrible. Equal space is given to the minor participants at Geneva—Britain and France, by Antonio Varsori and Colette Barbier respectively—in what one presumes is the interest of even-handedness. The chapter on West Germany by Eckart Conze is most valuable for demonstrating how aercely Konrad Adenauer resisted what many other people hoped for: the application of the Austrian model to Germany (a “deadly danger,” Adenauer called it, p. 197). John Prados provides new details regarding what has been known for some time about the ace up Eisenhower’s sleeve in proposing an overoight program—“Open Skies”—that he knew the Soviet Union would reject, namely the U-2 spy plane. The sum of the stories of the several authors is that the Geneva summit was a failure only by the standards of the naive public. The conference came and went, leaving little but propaganda in its wake, precisely because propaganda was all that the major

!)r. Farre on the Morbid Anatomy of the Liver. 153 u Tuber A Circumscripta.?Tubera determinate in their figure, and limited in their seat chiefly to the lungs. " Tubera Diffusa.?Tubera indeterminate in their figure, diffused through the affected organ, or dispersed in many textures of the body." In his definition of Tubera Circumscripta, Dr. Farre has corrected Dr. Baillie, who describes the disease as "the large white tubercle of the liver." Dr. F. contends that " the epithets large, white, are not characteristic, being common to both species, and belong indeed in a more remarkable degree to Species II. It seemed to him also objectionable to apply the term Tubercles indifferently to these large tumors, to certain irregularities of surface produced by chronic inflammation, and to scrofula." Of the first order, Tumores, the liver is chiefly subject to Tubera Circumscripta, thus described by Dr. Farre: " Their color inclines to a yellowish white ; they elevate the peritoneal tunic .of the liver ; and their projecting surfaces, slightly variegated with red vessels, deviate from a regular swell by a peculiar indentation at or near their centres, which are perfectly white and opaque. They vary much in size, which depends on the duration of each tuber; for at its first appearance it is very minute, but during its growth it assumes the character above described, and at its maturity exceeds an inch in its diameter. They adhere intimately to the liver, and their figure is well defined. In the interstices of the tubera, the liver is paler and more flabby, its cohesion is weaker than natural, and slight effusions of blood are sometimes found. They commonly remain distinct at the surface of the liver, but internally they ultimately coalesce, and form immense morbid masses which pervade its substance. The patient often lives until the mass occupies the greatest part of the abdomen, and the natural structure of the liver is nearly supplanted. They possess so close a cellulaf structure, that the section of them, at first view, appears solid and inorganic ; but on the edge of the knife, by which they have been dissevered, an opaque white fluid, of the consistence of cream, is left, and a fresh portion of this fluid is gathered on it at each time that it is repassed over the surface of the section. Their cellular structure becomes more apparent after long maceration. " Symptoms.?The patient suffers pain in the region of the liver, languor, loss of appetite, and cough; but, until the liver,'by the growth of the tubera, descends below the hypochondria, a distinct judgment of the case cannot be fqrmed : then the functions of tlx? alimentary canal are more impaired, the body wastes, and the en largement of the liver, its hardness and remarkable irregularitv ot surface, may be distinguished through the parietes of the abdomen. In the advanced stage the patient is distressed by its enormous bulk ; the respiration is oppressed; the bowels are prone to diarrhcea. Neither jaundice nor serous effusion into the peritoneum are sympyq. 163.
x touratis 154 Critical Analysis. tomatic of this disease: they may be conjoined, but it is an accidental circumstance, rather than a necessary consequence." Two well-related cases, with the dissections, and illustrated by a plate, remarkable for the beauty of its execution and the accuracy of its delineation, terminate the author's history of Tubera Circumscripta; or, as the disease has been named by Dr. Baillie, " the large white tubercle of the liver." Besides his objection to the term adopted by this distinguished writer, Dr. Farre dissents from his notion that the disease is scrofulous, and grounds his opinion on these circumstances : "First, the Tubera Circumscripta are distinctly allied to the Tubera Diffusa, which unquestionably fall under the tribe of fungous diseases. Secondly, the Tubera Circumscripta differ from theTubercula Strumosa in their character and termination." Dr. Farre admits that the disease is occasionally " conjoined" with scrofula; and, should the reasons that he has offered for rejecting the notion of Dr. Baillie be deemed slight or insufficient, will a candid objector regard that celebrated physician's opinion to be founded on strong evidence, when, describing the nature of the large white tubercle of the liver, he says, . Two fatal cases of this disease, with the appearances on dissection, and a plate, complete the present fasciculus.
From the author's experience, neither of the complaints above described are benefited by the use of mercury; " for, by the time that the most careful examiner can distinguish them, the progress of the disease has been already so considerable, that the mercurial action tends only to exhaust powers, which art will subsequently in vain attempt to restore.'1 Although we cannot dispute the accuracy of this assertion, so humiliating to the powers of medicine, we venture to hope that a period may arrive, when the cause, origin, and progress, of these complaints shall be better understood ; we even think that Dr. Farre's individual exertions will effect some improvement in our knowledge of them; and that his successful cultivation of the anatomy of morbid parts, will eventually produce a better result than the melancholy satisfaction of ascertaining the incurable nature of the disease. During the various attempts, recited in our last, for retarding the progress of the casual small-pox, the report of the'Jcnnerian discovery reached the eastern world ; and soon after the original works of Dr. Jenner, and that, of Mr. Aikin, gave authenticity to the report. As early as the year 1800, attempts were made, but unsuccessfully, to transmit the vaccine fluid to India. Various other attempts, with a similar result, marked the endeavor to extend this blessing \ but the difficulties were at length overcome. his government, or the cause of humanity, had proposed that vessels, with proper subjects, should be sent to Bombay and the Persian Gulph, for the purpose of importing the virus on inoculated patients,* if Lord Elgin should be fortunate enough to succeed in transmitting il from Constantinople. " At length we had the pleasure to learn, that the object of our wishes was accomplished, and that the disease was produced at Bombay, and soon afterwards at Trincomalie, whence it was diffused over Ceylon, transmitted to the Coromandel Coast, and thence by Dr. Anderson, in the ship Hunter, to Bengal; but, as it seems of importance to trace distinctly the source ot the matter which is so extensively diffused in the eastern world, and to account for its rapid extension throughout Ceylon, it will be satisfactory to copy some letters and other documents on this subject, which were written at the time, and most of them published in the different Indian papers.* " At the period of the first introduction of the vaccine virus into. Ceylon, a regular establishment existed for the promotion of smallpox inoculation, to which the natives were in a great degree familiarized, and it was only necessary to transfer the services of the individuals composing this establishment, to the preservation and diffusion of cow-pox, which the natives, in the first instance, seemed to consider as a milder species of the same disease ; and it is to the decisive measure of government, in immediately adopting this plan, and the steady and liberal support afforded to it, that we ought to attribute the more rapid extension of the practice on its first introduction into Ceylon, than in Bengal, and some other parts of India, where, though similar measures were adopted, yet the establishment remained to be organized, and the prejudices of the natives against inoculation in general, at least as received from the hands of Europeans, to be overcome." These * It may not be unacceptable to our readers, to see the following account of the introduction and propagation of vaccination in India.
?' To the Editor of the Bombay Courier.
" For the satisfaction of the public, and the information of professional men in India, we beg of you to publish the following account of the introduction of cow-pox into this place. We have it now in our power to communicate the benefit of this important discovery to every part of India, perhaps to China, and the whole eastern world.
We shall spare no pains in accomplishing a purpose so desirable, an object by which one of the greatest evils that has afflicted humanity may be diminished in a great degree, or even extinguished altogether.
In the course of the last twelve months, we have repeatedly received by sea from England the vaccine matter, and many children |iave been inoculated to no purpose./ We were not more successful >yith ?natter which was sent us directly by land from Constantinople. fortunately* ' These unsuccessful experiments to introduce vaccination into the island of Ceylon, were followed, in August 1802, with one favorable case at Trinconialie, from which was supplied the material for spreading the practice to other parts.
Fortunately, Dr. Short, a surgeon of this establishment, residing at Bagdad, produced the disease at that place. " He immediately forwarded the matter to Bassorah, where Mr. Milne, the surgeon of that presidency, also succeeded in infecting a patient with it. Mr. Milne soon afterwards inoculated a number of other children, and he sent the vaccine matter to Bombay by several ships. Even with this matter we were for a time unsuccessful, and after thirty or forty trials by various methods and by different surgeons. " A fortunate inoculation at length produced the vaccine disease in Anna Dusthill, who is perhaps the first human being who underwent it in India. This child, the daughter of a servant of Capt. Hardie's, i& about three years of age. She is very healthy, and certainly never had the small-pox. It is necessary to mention these circumstances, as from her alone the whole of the matter that is about to be sent all over India was first derived. " We have received no history of the patients from whom it was taken at Bagdad and Bussorah, but we rest with confidence, from the knowledge of the medical gentlemen at those places, that no pains have been spared to make it pass through unexceptionable bodies.
" From Anna Dusthill, on the eighth day of her disease, and 22d of last month, seven children were inoculated; five of those, who certainly never had the small-pox, took the infection, and have already gone through nearly the whole course of the vaccine disease. The other two were not infected, but there is some probability that one of them has had the small-pox. From the five children that were infected, about thirty more have been inoculated, and a great many of them no doubt will take the disease. From these last we shall send the vaccine matter to the other presidencies, to Surat, Poonah, &c.
&c.; and care shall be taken that none shall be employed but from an unexceptionable source.
" The vaccine disease in Anna Dustlrill passed, as we have said, through its ordinary course, as described by writers on the subject. " The pustule began to show itself about the third day ; during the course of the fifth and sixth, she had slight symptoms of fever, and some uneasiness in the arm-pit of the inoculated side. The pustule on the eighth day was of the proper size for that period. It was flat, rather concave, and it consisted of many cells, which on being pricked gave out a transparent fluid. By the tenth day the inflamed areola round the pustule was .extensive, and very distinct, in spite of the blackness of her skin. She had only a single pustule on the inoculated part, nor during the whole time did she suffer any material inconvejiiency from the complaint. All the five children who were inocujstcd from her, had a similar train of complaints. On two, whose s parents parents were Europeans, the inflamed areola, from the whiteness of the skin, was much more-distinct than it had been on Anna Dusthill. We have thus detailed the progress of the symptoms, and we have no doubt but that this is the genuine cow-pox. Some surgeons here, who have seen the disease in England, are of the same opinion ; we hope, therefore, that this will tend to quiet the apprehensions of parents, which in some instances we find to be very great; and that oar experience at this place, so far as it has gone, will give confidence to practitioners. " Almost all the medical men at this presidency have witnessed the disease, many of them are inoculating for it, nor do I understand that any difference of opinion has arisen concerning its nature. " One test indeed we still want of its genuine nature, and that is, its power of preventing the variolous infection; to this test it shall shortly be put. As this island does not contain less than 150,000 people, sufficient supplies of children must arise to keep up the disease, even without any dependence on Salsette, or the neighbouring continent. " The Hindoos and Persees here both shew the utmost desire of having their children inoculated with the vaccine disease. We shall instruct the native practitioners of physic regarding it, but on this part of the subject we are not without apprehensions. Whoever is sufficiently acquainted with what has been done in Europe, with regard to the cow-pox, is aware that some foreign poison, such as that of the small-pox, is apt to be mixed with it, whence a compound disease arises, or some other poisonous matter may be, from various causes, introduced, instead of the vaccine virus, whence a disease altogether different is produced. The History of the Count De Moffet, as detailed by Dr. De Carro, affords a most instructive lesson on this subject. The greatest care, therefore, should be employed, to warn the native practitioners, that the vaccine nutter may be degraded, by many causes, and their utmost attention is necessary to prevent it. " We can affirm from our own knowledge, that this government have anxiously assisted our wishes for procuring the vaccine disease, by the way of Bussorah. They represented to Lord Elgin the importance of it to this great society of mankind, and they called for the aid of the residents of Bussorah and Bagdad. Dr. De Carro, of Vienna, who has distinguished himself so honorably in this career, transmitted in the first instance the vaccine mailer to Lord Elgin, who several times before had shewn us his attention to the subject. By his lordship's orders, it was sent to our resident at Bagdad, and again to the resident at Bussorah. To both those gentlemen the public are under great obligation, for the interest they took in the subject.
Finally, it fell into the hands of Dr. Short and Mr. Milne, as we have already said, nor could it have been more fortunately placed.

I5J)
" That, after various failures at the different stations on this island, the vaccine inoculation lias at length happily succeeded at Trincomalie, with matter taken from the arm of a child of European parents, at Bombay, on the eighth day from inoculation, being the IOth of July. The matter was sent by Dr. Helenas Scott, under cover to Mr. North, and did not reach Trincomalie till the 11 th of August.
Several patients were on that day inoculated with this matter, by Mr; Rogers, medical superintendant at Trincomalie; but, as in former cases, it failed of success in all, except in John Sybille, a halfcast boy, of twelve years of age", in whom it very fortunately took effect. On the 20th of August, being the ninth day from inoculation, a distinct pustule was formed on the inoculated part, bearing the characteristic marks of the cow-pox, and attended with pain in the axilla, and slight fever, so that Mr. Gilbert Hall, surgeon of the Malay corps, who, in consequence -of the absence of Mr. Rogers, had charge of the patient, had no hesitation in pronouncing it to be the true vaccine disease. He immediately inoculated thirteen patients from the arm of the boy, in all of whom, he informs me, the inoculation had evidently taken effect, on the 26th of August. The most effectual measures have been ordered by this government for keeping up the disease, and extending it as expeditiously as possible to the different stations on this island, and to the Coromandel Coast, by means of inoculated patients. The fortunate event of John Sybille's inoculation with matter thirty-two days old, should teach us not to despair of success with dried matter, which has even been kept a considerable time in a hot climate; but the very frequent failures with dried matter, both in Europe and in India, shew that it is at best but a very uncertain means of conveying the contagion to any considerable distance." After the fortunate event of the vaccination of John Sybille at Trincomalie, the vaccine disease was speedily communicated by vaccinated patients, or by impregnated threads, to every part of Ceylon. The history of the progress of vaccination in this island, its successes, its failures, and the opposition made to it, are detailed in, and authenticated b\', various public documents, for the particulars of which our readers must be referred to Dr. Christie's pamphlet. In 1S03, there was considerable evidence of the security afforded against small-pox, by vaccination; but some in-. " We have been more particular than necessary for the medical profession, who must be supposed to be in possession of every fact that has occurred on the subject in Europe ; but, as we shall disperse the vaccine disease very widely, and as it will affect, and as vye hope it will promote the happiness of, every family, we wish to satisfy the public at large, concerning the sources from which we have derived it, and the foundation of our belief that it i,s of a genuine kind. .stances Critical Analysis* stances of failure having occurred, or being reported to have occurred, the necessary investigation was made to as'-' certain the facts, which did not prove permanently injurious to the reputation of vaccination.
In 1&04, Dr. Christie made the tour of Ceylon, for the first time after the commencement of the Candian war, and found that the vaccine disease existed in perfect purity, at all the principal stations in the island, and that the inhabitants generally placed confidence in the preservative efficacy of the cow-pox, except in the district of Jaffnapatnam, where the disease had become extinct, and the practice of vaccination got into disrepute, in consequence of a spurious disease having been introduced; after passing through which, several persons caught the small-pox and died.
" In 1805, the practice of vaccination continued to be followed with the most perfect success ; and, although the small-pox prevailed in the Candian country in the month of May of that year, it did not extend to the British possessions; but, on the contrary, the alarm created by it on the frontier, increased the number of applications for vaccination ; and it appears, from the report of May 1805, that the number of patients vaccinated during that month, in the Columba v district alone, amounted to 486 ; and that, on the south-west side of the island, we enjoyed a perfect exemption from small-pox. " The impression whicl> the security from small-pox acquired by the practice of vaccination, made on the minds of all classes of inhabitants in Ceylon, will be best expressed by extracts from the addresses presented to our most excellent governor, on his departure from the island, in July 1806. " Extract of an Address from the Civil, Judicial, and Military Officers, resident at Columbo, to his Excellency the honorable Frederic North, Governor. " The natives under your government will long remember your Excellency with reverence and gratitude, as the founder of seminaries for their improvement in religion and knowledge, and of various institutions of charity for the relief of their sick and poor, and most particularly for the incalculable blessing you have brought on this island, by the successful introduction and rapid extension of vaccination." " Extract from the humble Address of the Native Headmen, 4'C. to his Excellency the Honorable Frederic North, tyc. tyc. " Your Excellency's care for their well-being extended, itself so far as not only to favor them with lands for cultivation, but also, perceiving that the small-pox made every year a sad slaughter amongst the natives, (who from nature are fearful of the same in the highest degree,) did not spare any expense to accustom them to inoculate, by which means, at present that fatal complaint being extirpated, the old men and women in the interior of the country declare that they are become happy parents, through the preservation of their children bv inoculation, [vaccination,3'} t)r. Christie on Vaccination in Ceylon* 1(j1 tc In the year 1806, the number of vaccinations considerably in* creased ; and in January of that year the contagion of small-pox became extinct in the district of Jaffiiapatnam, by means of vaccination, which had been very successfully and extensively practised there since its re-establishment in March 1S05.
"In February 1806, the only part of Ceylon where small-pox existed was Aripo, where a great concourse of strangers was assembled from the different parts of India for the purpose of attending the pearl fishery, and where the disease was introduced Jjy a man who landed from the coast with small-pox, which unfortunately was com niunicated to a few other persons, before the necessary measures for prevention could be taken.
" On the breaking up of the fishery, in April, the disease was brought to Columbo, where we had enjoyed an exemption from it since 1804 ; but it did not spread to any extent, and the alarm occasioned by its appearance greatly increased the number of our vaccinations, at the same time that the existence of the contagion afforded us an opportunity jof proving by variolous inoculation and exposure of our patients the continuance of the purity of our vaccine matter, and, as far. as possible in the island, the permanency of its preservative efficacy, in opposition to the idea of Mr. Goldson, whose cases fcegun at this time to be talked of in Ceylon," , '' A few cases of small-pox continued to occur at Columbo for some time, bill no patient who had been vaccinated caught it; and the vaccinations, which were greatly increased by the circumstance, amounted in all to 54,958 at the end of the year 1806." Ill 1807 the small-pox appeared and spread in the district of Trincomalie; in consequence of which Governor Maitland issued an advertisement, the success of which is evidenced by the report on the progress of vaccination published at the end of that year.
The progress of vaccination in 1803 and 1809, is detailed jn the following letters : " To the Editor of the Ceylon Gov. Gazette. " I inclose an abstract of the number of patients vaccinated throughout the different districts in Ceylon during 1808, amounting to 26,207, which exceeds the proportion of any former year; and, when added to 76,328, the number previously vaccinated, makes a total of 103,035 persons who have been officially reported to me, as having regularly' passed through the vaccine disease, since its first introduction into this island in 1802. " The dreadful ravages which the small-pox usually committed in Ceylon, previously to the introduction of vaccination, must be in the recollection of every one; and it affords me infinite pleasure to observe, that, agreeably to the most certain information I have been enabled to procure, that destructive malady has not existed in any part of the British possessions on this island, during the year 1808, except in the district of Galle, into which it was brought on the 31 sc of January by a Maldivian boat last from Bengal, i<o. 168. T "A large I 162 Critical Analysis.
" A large proportion of the crew of this boat died, and the diseas* was communicated by a fisherman, who visited it on its first arrival, to two or three of the inhabitants of the neighbourhood of Galle, but spread no further, which must be attributed chiefly to the favorable influence of vaccination, which had been so extensively diffused in that and the other districts of the island.
(Signed) " T. CHRISTIE. " Colombo, 10lh Feb. 1809." " I subjoin, for more general information, an abstract of the number of patients vaccinated in the different districts in Ceylon, during JS09, amounting to 05.6j7 ; which, added to 103,035, the number ?vaccinated in former years, makes a total of 128,732 persons who have been officially reported to me by the respective superintendents and vaccinators, as having regularly passed through the vaccine disease, since its first introduction into this island in 1802, besides a few others inoculated by individuals, not belonging to the vaccination establishment.
" Agreeably to the best information I have been able to obtain, the small-pox "has not existed in any part of this island since February 1808, till October last, when the disease was brought to Jaffhapatnam by a<country boat from Quilon on the Malabar coast. The contagionspread to a few individuals, who had not been vaccinated in the Pett'ah of Jaflhspatnnm, and, by means of a civil prisoner, was introduced into the jail of that place, but its progress was immediatelyarrested by the indiscriminate vaccination of all the other prisoners. * " By a late report from Mr. Stutzer, superintendent of vaccination 'at Jaffnapatnam, it. appears that there were only six individuals ill of the small pox in that district, and it has found its way to no other part of the island except Putlam, where a Coolie from Jaffna was Xaken ill with small-pox in December last, but has since recovered without communicating the disorder to any other person. " The vaccine disease has now been so extensively diffused throughout this island, that, while inoculations continue so frequent as at present, we can have no reason to apprehend that the contagion of small-pox will ever spread epidemically, in any part of the British possessions in Ceylon; and its occasional appearance here, has the good effect of proving the preservative efficacy of the vaccine, ancl of rousing the natives from their apathy on the subject, as exemplified at Jaffhapatnam, where 1830 people have been inoculated during tiie two last months, and amongst them several Bramins, men and women, who had hitherto declined submitting to the operation. " I shall only add,'that, with a view of proving the permanency of the preservative efficacy of cow-pox, and the continuance of the purity of the virus on this island, Mr. Stutzer has, at my request, in Kovember and December last, inoculated with small-pox matter seveial patients who had passed through the vaccine disease in I SO 4and 1S09, all of whom have resisted the conta ;ion.
(Signed) "THOMAS CHRISTIE." "Columbo, 2 \th Jan. IS 10." To this account of the progress and success of vaccination, in the island of Ceylon, to the final expulsion of the variolous lous contagion, the author subjoins some observations on the laws by which the vaccine disease appears to be governed in a tropical climate.
" According to the most attentive observation, the vaccine disease in India seems to have been governed by the same laws as in Europe, and the ordinary course of the disease, as remarked in Ceylon, agrees perfectly with the description given by the Medical Board of Bombay, in their letter, page 23. " The vaccine matter had been constantly kept lip in Ceylon, bv a succession of patients, since its first introduction in the case of John Sybille, in August 1802, till the time of my leaving the island in February 1810, during which it had passed through at least 390 persons in succession ; but its genuine nature had not been in the smallest degree altered, and its preservative efficacy remained the same, as proved by experiments at JafFnapatnam, in November 1809; and, when properly applied to a person who had not had the cow-pox or small-pox, and was free from eruptions, and otherwise healthy, it seldom failed to produce the true vaccine vesicle.